So your mom's finally tucked safely away in her new retirement home. New friends, good food, lots of fun activities to broaden her world again. There's even a licensed professional who watches out for her 24-7, making sure she's safe . . . dispensing her meds. No more worrying whether or not she's eating enough. No more frantic calls over forgotten doses or lapsing prescriptions. Then it happens. The reality of drug addiction nudges closer to home when you discovers a painful reality. . . the reason mom's drugs don't work is because mom's not getting her drugs.

~~~

Then it happens. Another day you've been dreading. Your mom calls from her assisted living home. She's fallen again and her pain is beyond excruciating. Her doctor checks her out. Nothing's broken so he prescribes Lortab for her pain and sends her home.

But the Lortab doesn't work. Several days later mom's still calling your office every couple of hours, sobbing into the phone. You wonder if she's re-fractured her pelvis. She can't eat. She can't sleep. And neither can you. But wait. Sleep is the key word here. The few times you've been prescribed Lortab, it absolutely knocked you out. Forget the pain. How is it she's even staying awake? She's so tiny. How can she handle a drug that potent when you can't?

Her doctor doubles the dose. No change.

So you stop by for a brief consult with the nurse on duty. "Is mom taking her Lortab?" you ask. Oddly, this chronically jolly nurse you've chatted with so many times before bristles. You revise your approach. "You know mom has trouble swallowing those big pills. Do you think maybe she's just pretending to swallow the Lortab and spitting them out when you're not watching?" By now the nurse is borderline belligerent. Maybe she's having a bad day. Or maybe she believes you're questioning her competence and not your own mother's intermittent trickery.

You take mom back to her doctor. He prescribes a Duragesic patch. A staggering sixty-three-dollar-a-dose-stick-on-the-skin patch. But it's worth it. Her pain is gone. She's sleeping. You're sleeping. And you can actually work again, now that the hourly crisis management is over.

What happened? Why did the patch work and the oral Lortab not? Of course the patch is a direct application. But shouldn't the Lortab have provided some relief? Shouldn't she have been just a little drowsy?

A few weeks later you suspect the answer. A nurse in a neighboring facility is arrested for stealing Lortab from her patients. A month later, another nurse is discharged for "mismanaging" her patients' Lortab.

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Lortab or Lorcet or Vicodin or Norco . . . the generic ingredients for all these drugs are Acetaminophen and Hydrocodone Bitartrate. Similar drugs are those containing Oxycodone Hydrochloride such as . . . OxyContin.

Who knew? Apparently everyone else but me, particularly those we trust to care for our loved ones. Of course the news is rife with one celebrity or another's addiction to OxyContin. But now it's my problem. As it is perilously up close and personal for anyone who trusts another to administer his or her drugs.

GoUpstate.com reports that more than one of every one hundred nurses in Spartanburg, Cherokee and Union Counties, South Carolina have been disciplined for drug-related offenses, including stealing prescription painkillers from nursing homes, doctor’s offices and hospitals.

And in New York, a pretty 30 year old looks-like-the-girl-next-door practical nurse was caught stealing hydrocodone pills from a nursing home in Springfield. This same nurse was already under investigation in another county. www.wkbw.com

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Ironically, the police and the nursing home officials believe none of the patients missed their medications. How would they know? Perhaps what they mean is no one died. One giant bullet of a white pill looks just like another when you’re in pain or when you take a daily mega assortment of pills. In fact, how easy it would be to slip an unsuspecting patient a harmless calcium pill in place of the Lortab tablets pictured in this DEA photo.

This is not the first foul-up in medications mom’s experienced. And it’s far from the most serious. Some serious medicinal mistakes were hospital related and a few whoppers were caused by that one really bad ex-doctor.

But for caregivers the fundamental message here is simple. Don’t implicitly trust “the system.” If it doesn’t feel, smell, look, or act right, it might not be. Keep that pill book tucked in your caregiver’s tool kit, not just for mom, but for yourself as well. And not just for the medicines that don’t work but for those unanticipated subtle side effects that build slowly over several months becoming a recognizable a risk only after enough time has lapsed to forget there’s been a change in medication.